Monday, November 14, 2005

Beware "herbal" remedies

Well, isn't this interesting?
Scores of traditional Chinese medicine stores in Britain's high streets are being investigated for selling illegal medicines, the BBC has learned.

Radio Five Live has discovered that 67 outlets selling Chinese medicines are under suspicion.

It is estimated that 6,000 stores across the country offer treatment for conditions ranging from eczema to the menopause.

But the industry, although growing in popularity, is largely unregulated.

At the Herb Garden store in Leigh on Sea, Essex, an undercover reporter from the Five Live Report was two weeks ago sold a herbal slimming pill and told it contained rhubarb and honeysuckle.

Tests showed it contained fenfluarmine - an illegal pharmaceutical considered to be so dangerous that it is banned in most countries worldwide, including the UK.

The owner of the store, Anna Yang, was prosecuted earlier this year for illegally selling the same drug.
Alties like to tell us that their products are more "natural," that they're effective but much safer than conventional drugs. One wonders why, if that were the case, these particular sellers of "traditional Chinese medicines" in Britain would be so tempted to spike their "herbal slimming pills" with fenfluaramine, an effective albeit dangerous weight loss drug. (Fenfluramine has been banned by the FDA and is also illegal in most other countries because it has been linked to heart valve problems, particularly when taken with dexfenfluramine, the compound being known as Fen-phen for short.) Surely if their herbal remedies were so effective and safe, there would be no incentive to risk prison to pull a fast one like this, would there?

But that's not all. The same BBC reporter was sold two other prescription-only drugs:
The BBC reporter was also sold two other prescription-only drugs - Danthron - a specialist laxative which has cancer causing properties and is only recommended for use with terminally ill patients, and Sibutramine - prescribed in cases of extreme obesity.
I am not familiar with either of these drugs, but a brief search showed that Danthron is carcinogenic, causing a large increase in adenomatous polyps of the colon in rats, and that it causes genetic damage in in vitro cell culture systems, with the money quote being: "Products containing Danthron as a laxative are no longer generally recognized as safe and effective and may not be marketed in the United States." Apparently, however, it is still used in Britain in the limited situation of severe constipation in terminally ill patients.

If you think this doesn't have a human toll, think again:
Dr Karl Metcalfe, a consultant physician at Southend hospital said he has treated nine of Anna Yang's former patients but fears there may be more as some people may not have reported symptoms to their GPs.

"For a medically qualified person to be issuing these drugs would be reprehensible.

"For a non medically qualified person to be doing it is well very alarming and quite clearly criminal."
Another doctor, Dr. Mark Thurz, agrees:
Dr Mark Thursz, a consultant physician at St Mary's Hospital in Paddington said he had seen a huge rise in the number of patients being referred to him with liver failure or hepatitis after taking Chinese herbal medicine.

He said: "Many people believe herbal remedies are safe, but they should be seen in the light as conventional remedies in that they can adverse reactions.
Precisely. In the U.K., it's gotten so that even the Association of Traditional Chinese Medicine is calling for tighter regulation of herbal remedies.

The lessons from this case, even though it happened in the U.K., are applicable to the U.S., because herbal medicines and supplements are just as poorly regulated here as they are in the U.K. You have very little assurance that the herbal remedies you purchase contain what they say they contain and in essence zero assurance that they do what the sellers claim they will do. Remember this as well: If a supplement, herbal remedy, or other treatment has any real effect on your body, it is acting as a drug, and all drugs have side effects. For all drugs, it is a question of risk versus benefit, whether the benefits of the drug outweigh its side effect profile and risks. In the case of fenfluramine, the benefits were outweighed by the risk of heart damage, which was why it was banned.

The distinction by alties between "natural" medicines and "artificial drugs" (those manufactured by drug companies) is artificial and designed to fool the unwary. Any "natural" or "herbal" remedy that has an objectively measurable therapeutic effect in your body is acting as a drug. Indeed, many of the drugs we use today for many purposes were initially discovered in nature, in plants or molds, or whatever. Penicillin, as most people know, came from a common mold. Digoxin is isolated from the foxglove plant (Digitalis purpurea). Taxol, now used to treat breast cancer and other malignancies, was isolated from the bark of the Pacific Yew tree. The difference is, when you use herbal remedies, unlike the case for drugs manufactured by pharmaceutical companies, you have very little assurance that you will actually be getting the correct amount of therapeutic components, that the amounts of those components won't vary considerably from lot to lot, or that the herbs haven't been treated with pesticides or spiked with something else. The whole reason "conventional" medicine moved away from using drugs directly in the form of plants or natural products and towards isolating the active components of those plants in purified form was to avoid these problems of variability and uncertainty in dosing. That is why, when you purchase, for example, digoxin, you can have assurance that, each time you buy it, a 0.125 mg pill will contain 0.125 mg of Digoxin within a very narrow range of variation and that it will not be adulterated with other components. You could munch on foxglove leaves, as was done before the active component was identified, but you'd be taking a chance. Given the narrow therapeutic window of digoxin, you'd have a high probability of either taking a dose too low to be therapeutic or of overdosing yourself.

The bottom line is that alties will raise a huge ruckus about problems with drugs like Vioxx being found after they have been approved by the FDA and on the market. Fair enough. Safety testing of drugs before approval has occasionally failed, but for the most part drugs that make it to market are safe and effective. Those that aren't are usually discovered fairly soon after release and use by a large population. Also, pharmaceutical companies pay a heavy price in terms of lawsuits if their drugs are found to be unsafe, an additional incentive to make sure that they are, in fact, safe. No such regulatory mechanism exists for herbal remedies and "supplements." This lack may not have been such a big deal a couple of decades ago, but, with more and more people using supplements and herbal remedies, this situation is no longer acceptable.

7 example(s) of insolence returned:


At 11/14/2005 8:19 AM, Anonymous Anonymous said...

Love that last point you made there. Well said.

-Ali

 

At 11/14/2005 8:49 AM, Blogger The Probe said...

There is absolutely no doubt in my mind that the US has to move to a uniform standard of regulation for anything sold where the use is to affect the body as a medication would do. The herbal/supplement/magic potion industry, on occasion, posts a disclaimer attempting to avoid running afoul of the FDA/FTC, but these are often impossible to read as they are in micro-font size.

 

At 11/14/2005 10:56 AM, Anonymous J. Ken Wickiser said...

Orac said, ... but, with more and more people using supplements and herbal remedies [snip]

Without straining myself to do a search, is this true? And if so, has the prevalence increased proportionally with internet traffic?

Also, I wonder if the % of people using alt med has not increased but maybe just the amount and different flavors of these products used by each consumer has increased. In other words, there is a fairly constant fraction of the population who will go for this stuff and maybe the net has improved their capability to get more and more types of it.

Also, on some lists I've seen certain people really going off on CODEX like it's another secret organization designed to subvert humanity. I'm wondering if Art Bell has done a take on it?

Somewhere Senator Hatch sits back, turns up the latest MTC CD, dreams a little dream about baseball and money.

 

At 11/14/2005 2:23 PM, Blogger mtraven said...

While I mostly agree with you, especially the obvious points that herbs are drugs, there is a political context to this that should not be ignored. Half of the craze for herbs and supplements represents a desire for people to manage their own health care in a context outside of the medical-industrial establishment. You can't get your Digoxin pill without going through a doctor and the incredibly inefficient health insurance system, but herbal remedies are available for simple cash at the mall, and you can manage your own care through reading the web. I'm not saying this is a good way to treat one's health problems, but the desire for people to get control over their own care is a good thing.

The medical-industrial system leaves out people without insurance, it leaves out remedies that are not patentable or profitable, and it leaves out medical problems that are too subtle or idiosyncratic to fit official diagnostic categories. Alternative medicine, despite its many many flaws, is filling these economic niches. It won't go away until real, science-based medicine learns how to deliver what people want and need.

 

At 11/14/2005 7:29 PM, Anonymous Anonymous said...

I so much agree with the above comment. In my own case, I HATE going to the regular doctor. It is very demeaning and demoralizing. I would rather try a supplement than go to a traditional doc. I opt for reputable supplements like GNC, Walgreens, or Wal-mart. It is truly a horrible experience for a doc to dismiss your symptoms, tell you you're crazy, and kick you out the door with a sedative or an anti-depressant Rx. I gave up on docs. I don't know why docs are so easy to dismiss people when their whole career to supposed to revolve around healing people.

 

At 11/14/2005 9:02 PM, Blogger Pierce Wetter said...

Lot's of points to make!

1. As an "altie", I have to tell you that we have to inspect all of our herbs when we order from China, because you're right, outside of the "patent medicines" that are produced in factories, there's very little quality control.

2. Some of your sneering at Chinese herbalism is misplaced. Much of the materia medica that Western pharmacology was based on came from testing herbal lore. While asprin is the obvious (and boring) example, there are plenty of others.

Chinese Herbalism was not available to the people who created Western medicine, otherwise, there would be plenty of prescription medications based on Chinese herbs I expect.

3. In the US, the FDA got shut down from trying to regulate the Chinese herbal medications because of freedom of speech/cultural issues.

4. Using fen/phen for weight control is anathema to pretty much the whole concept of Chinese medicine. You're overgeneralizing from a couple of isolated cases. For shame! I thought you were a scientist!

A Chinese medical practioner is much more likely to prescribe eating better and exercise then a Western practitioner in my experience. Any herbs we would prescribe would be to assist the patient to desire the right foods by compesating for whatever imbalance they have.

5. Chinese herbal tradition includes a lot more dangerous stuff then you can get even via prescription. (some are literally poisons). Yet, all medicines even herbals ones are considered poisons in Chinese herbal tradition. So what's your point exactly? Western poisons are better then Chinese poisons?

6. There are very few herbal medicines I would prescribe to a patient "for life". Yet I see patients all the time who have come in with some drug they've been taking for years...

Don't get me started on Ritalin...

7. There's "voodoo" in both Western and Eastern medicine. Personally, I'm a big believer in doing both, and being cynical about both.

 

At 11/14/2005 11:14 PM, Blogger Greg P said...

Uh, wait a minute..."inspect all our herbs"...like in visually inspect because you can tell what something is by looking at it? Or do you send samples to a lab to check to see what they're made of.

The reason that "patent medicines" came about was to standardize and purify the substances that people were taking. It wasn't that digitalis leaf tea was by definition bad, but it was important to know how much of the active compound you were getting, since too much could be lethal. Plus it was good to know which chemical component out of many was the "active" one, and maybe also get rid of noxious or dangerous ones.

Some people get highly suspicious and read every last word of a drug insert with great scrutiny, but where's the insert for an herbal medicine?

 

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